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,_. <br /> E�F�Tt�lGA� PEF�lV�IT AP��lCATlO!`J <br /> CITY OF EVERETT PE'RMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - F.AX 425-257-8857 <br /> �l� J W �'�G /71 P � <br /> PROJECT ADDRESS • / � <br /> � lOYI � �� � /1 � +1 / \U(' C� - <br /> rr � <br /> Owner Mail Address Ciry � State2ip Phone <br /> 3� > � f��ro��,Pre � ���f �tt U.� f� � y�s-a58-� B � r <br /> Tenant Mail Addre,s City Slate2ip Phone <br /> Eleclrical Contraclor Mail Address Ciry �talo2ip Phone <br /> � <br /> � �L��/ �' �� — <br /> State License Number Contract Price ot Work <br /> Proposed Use of Building Contact Person (Plan Review) <br /> DescriptionofWorktoBeDone: �F �Cc �Y �P'�'J I C� 1�C�C�l2 � �(�O /���i (O� <br /> NOTE: PLANS FOR ELECTRICAL WORK AT EDUCATIONAL, FACILITICS UTILIZING STATE FUNDS MU$T BE <br /> APPROVED !'Y THE STATF OF WASHINGTON. APPLICANTS WITH SUCH JOBS MUST SHOW THE Sl'ATE <br /> EDUCATIONAL FACILBITIE�S AND ALL OHEALTH C E FACILITI SI PLANS WSLL BE R V EWED BY THIS OFFI OTHER <br /> NOTE: WIRIV, IN NON-DWELLINGS IS REQUIRED TO BE IN RACEWAYS, MC OR AC CABLE. <br /> HANDICAPPED ACCESSIBILITY: ELECTRICAL AND COMMUNICATIONS SYSTEM RECEPTACLES ON 1NALLS <br /> WITHIN ACCESSIBLE SPACES OR ALONG ACCESSIBLE ROUTES OF TRAVFL SHALL BE MOUNTED A MINIMUM <br /> OF 15 INCHES ABOVE THE FLOOR. WAC 51-20 SEC. 3106(c)2. <br /> ENVIRONMENTAL AND OTHER CONTROL RECEPTACLES AND OTHER OPERABLE E�UIPMENT WITHIN <br /> RANGESI OF WAC 51 2U�S C�3N 6(b)4CE & FI AND OT LES�S THAN 36LINCHES ABO E THE�LOOR.IN THE REACH <br /> II I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPUCATION AND KNOW THE SAME TO 6E TRUE AND CORFECT. ALL <br /> PROVISIO.VS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WHETHER SPECIFIED HEREIN OA <br /> O�NER OF�THIS P O ERTYMTO PER�ORM1T� THEUWORK FOREWH�CHR pp�0�COnNSTRMADE�ANOHACO�PL�WI�h/THEB TATE <br /> CONTRACTORS LAW 18.27 RCW ANO 296200 1NAC. <br /> � � /)'1 � ��j <br /> ���'/� ��,�, � FEE <br /> � �C�'L�G.��JI/`J'1,u'vlY l � _ <br /> Signature Date <br /> DEBIT&CRE�IT CARDS ARE NOT ACCEPTED E o�}t�5 -oR I <br />